RESUMO
Initial experience of extracorporeal shock-wave lithotripsy (ESWL) using the Lithostar lithotriptor is reported; 193 patients underwent 248 treatments for 210 stones. A total of 139 renal calculi (126 patients) and 71 ureteral stones (67 patients) were analyzed. Treatments were performed without anesthesia in 65 calculi (27.6%), with intravenous sedation in 91 (42.5%), and under epidural anesthesia in 34 calculi (29.9%). A three-month follow-up showed a success rate of 88.0 percent for renal calculi and 95.5 percent for ureteral calculi treated in situ. Renal stone fragmentation was achieved with a mean of 4,890 shocks at 17.4 kV and ureteral calculi were fragmented with a mean number of 4,798 shocks at a mean of 18.3 kV. Auxiliary procedures after ESWL were required in 2 patients with renal stones and in 1 with ureteral calculi. A comparison between stone size and number of shock waves required to achieve stone fragmentation revealed a linear relationship. Hospitalization was not necessary in 84.4 percent of renal calculi and 89.6 percent of ureteral calculi. Retreatments were necessary in 22 (15.8%) of the renal calculi (18 had 2 sessions, 3 had 3 sessions, and 1 had 4 sessions). Of the ureteral calculi, 8 (11.3%) underwent retreatment (6 had 2 sessions, 1 had 3 sessions, and 1 had 4 sessions). The low morbidity with a large number of patients treated on an outpatient basis, minimizing the need for anesthesia, demonstrated a favorable initial successful experience with the Lithostar.
Assuntos
Cálculos Renais/terapia , Litotripsia/instrumentação , Cálculos Ureterais/terapia , Brasil/epidemiologia , Feminino , Seguimentos , Humanos , Cálculos Renais/epidemiologia , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento , Cálculos Ureterais/epidemiologiaRESUMO
Between October 1989 and June 1991, 1,250 patients with urinary calculi were treated at our institution using the Siemens Lithostar. A total of 17 patients (1.37%) with radiolucent or slightly opaque calculi underwent lithotripsy with the Lithostar Plus, which has an overhead electromagnetic generator module and a localization system composed of a real-time on-line 3.5 mHz. ultrasound transducer. The stones were located in the calices in 52.9% of the cases, renal pelvis in 17.7%, ureter in 23.5% and bladder in 5.9%. Followup consisted of a nephrotomogram or ultrasound 1 day and 1 to 3 months postoperatively. Complete removal of all stone fragments was achieved in 76.4% of the cases after 3 months. Retreatment was necessary in 23.5% of the cases. All treatments were performed without anesthesia and hospitalization. Complications were present in 11.8%; perirenal hematoma was noted in 1 patient but this resolved spontaneously within a few days and the same occurred in 1 patient with renal pain. Extracorporeal shock wave lithotripsy using the Lithostar Plus proved to be an effective noninvasive procedure to treat radiolucent and slightly opaque urinary calculi. However, since the Lithostar Plus has a higher power setting, care must be taken to avoid damage with the use of high energy.
Assuntos
Litotripsia/instrumentação , Cálculos Urinários/terapia , Adulto , Idoso , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Cálculos Urinários/diagnóstico por imagemRESUMO
We reviewed retrospectively 145 patients presenting ureteral calculi above the iliac crest. According to the treatment three groups were established. Group 1 was represented by 24 patients submitted to posterior ureterolithotomy; group 2, 100 patients treated by endourologic procedures; and group 3, 21 patients treated by extracorporeal shock-wave lithotripsy (ESWL). Success rate considered as complete removal of all calculous material was 100 percent in the posterior ureterolithotomy group, 92 percent in the endourologic group, and 94.7 percent in the ESWL group. Hospitalization, anesthesia, and complication rates were minimal in patients submitted to ESWL. One may conclude that ESWL is the treatment of choice for lumbar ureteric calculi.
Assuntos
Cálculos Ureterais/terapia , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Humanos , Litotripsia , Região Lombossacral , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Cálculos Ureterais/cirurgiaRESUMO
The lower calix is responsible for a significant number of kidneys with residual stone fragments after extracorporeal shock wave lithotripsy (ESWL*). To compare the effectiveness of controlled inversion therapy as an adjunctive method to the elimination of calculous fragments, 42 patients who had undergone treatment for lower caliceal stones with a Siemens Lithostar lithotriptor were reviewed. Of the patients 25 had no adjunctive therapy and 17 underwent controlled inversion therapy. The success rate, effectiveness quotient and complication rate were analyzed. Followup consisted of ultrasound and a nephrotomogram 1 day and 1 to 3 months postoperatively. Complete removal of all stone fragments was achieved in 84% of the patients without an adjunctive maneuver and in 64.7% of those treated with controlled inversion therapy. The effectiveness quotient was 72.4% and 35.5%, respectively. The group treated without adjunctive therapy had fewer retreatment sessions and a lower complication rate. There were no complications related to the controlled inversion therapy and patient acceptance was generally enthusiastic. We conclude that controlled inversion therapy did not improve the results of ESWL for lower pole caliceal calculi.
Assuntos
Cálculos Renais/terapia , Litotripsia , Adolescente , Adulto , Idoso , Feminino , Humanos , Cálculos Renais/patologia , Cálices Renais/patologia , Litotripsia/métodos , Masculino , Pessoa de Meia-Idade , PosturaRESUMO
A total of 84 patients with superficial transitional cell carcinoma underwent transurethral resection of bladder tumor. All patients had stage pTa or pT1 transitional cell carcinoma or carcinoma in situ without other concurrent malignancies. The patients were assigned to three treatment groups: I. Control group-transurethral resection (TUR-BT) discontinued within the study. II. Oral BCG group-TUR-BT plus BCG (Moreau). III. Intravesical BCG group-TUR-BT plus BCG. Of 9 patients in the control group, 8 (89%) experienced tumor recurrence during a mean follow-up of 20 months. Of the 33 patients in the oral BCG group, 13 patients (39.3%) had recurrence during a mean follow-up of 39 months. Of the 42 patients in the intravesical group, 8 patients (19%) had recurrence in a 30-month mean follow-up. The incidence of complications was higher in the intravesical (33.4%) than in the oral BCG group (24.2%). These results showed that intravesical BCG is a more effective immunotherapy; however, oral BCG can be utilized in patients who do not accept intravesical BCG administration.
Assuntos
Vacina BCG/uso terapêutico , Carcinoma de Células de Transição/terapia , Imunoterapia , Recidiva Local de Neoplasia/prevenção & controle , Neoplasias da Bexiga Urinária/terapia , Administração Intravesical , Administração Oral , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma in Situ/terapia , Carcinoma de Células de Transição/cirurgia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Neoplasias da Bexiga Urinária/cirurgiaRESUMO
Percutaneous nephrolithotomy and extracorporeal shock wave lithotripsy (ESWL*) can be used in the treatment of lower pole caliceal calculi. In a retrospective analysis these 2 therapies were compared for treatment of solitary lower pole caliceal calculi to evaluate morbidity. During a 2-year period 23 patients treated with percutaneous nephrolithotomy and 24 who underwent ESWL with the Siemens Lithostar were analyzed in regard to the success rate, effectiveness quotient, complication rate, length of hospitalization and disability period. Followup consisted of ultrasound and/or a plain film of the kidneys, ureters and bladder 1 day and 1 to 3 months postoperatively. A nephrotomogram was included in the ESWL group. Complete removal of all stone fragments was achieved in 93.6% of the patients treated percutaneously without retreatment. In the ESWL group the success rate was 79.2% with a 41.6% retreatment rate. On the other hand, the ESWL group had a shorter hospitalization and an earlier return to normal physical activities. Among the patients who underwent a percutaneous operation 13% had complications compared to 4.1% in the ESWL group. The recurrence rate was higher in the former group (13% within a median of 18 months, compared to 8.3% within a median of 11 months in the ESWL group). The mean stone diameter was 1.42 cm. in the percutaneous group and 1.22 cm. in the ESWL group. Stone composition was similar in both groups. Since ESWL is an effective noninvasive procedure without the need for routine anesthesia and hospitalization, and with prompt return of the patient to a normal life it must be considered the method of choice for lower caliceal stones less than 2 cm. in diameter. However, percutaneous nephrolithotomy will continue to have a primary role in the management of larger stones.
Assuntos
Cálculos Renais/terapia , Adolescente , Adulto , Idoso , Feminino , Humanos , Cálculos Renais/patologia , Cálices Renais/patologia , Litotripsia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Nefrostomia Percutânea/efeitos adversos , Recidiva , Estudos RetrospectivosRESUMO
Two therapeutic methods, endourology and extracorporeal shock wave lithotripsy (ESWL), can be used in the treatment of ureteral calculi. In a retrospective analysis during a 2-year period 236 patients treated with endourological procedures and 71 who underwent ESWL with a Siemens Lithostar were analyzed as to the success rate, effectiveness quotient, complication rate and hospitalization. The mean stone size was 1.12 cm. in the endourology group and 1.03 cm. in the ESWL group. Complete removal of all stone fragments was achieved in 93.6% of the patients treated endourologically and without retreatment. In the ESWL group success was obtained in 90.1%, with an 11.2% retreatment rate. The retreatment rate was higher (25.0%) for calculi in the mid ureter. The group treated endourologically had a better success rate and no retreatment was necessary. On the other hand, the group treated with ESWL had a shorter hospitalization and a lower complication rate. Followup ranged from 11 to 60 months (mean 48 months) in the endourology group and 7 to 29 months (mean 11 months) in the ESWL group. These observations showed that in situ ESWL therapy with the Siemens Lithostar device is the method of choice for upper ureteral stones. Lower ureteral calculi should be treated endoscopically. Mid ureteral stones larger than 1 cm. had better results with endoscopic procedures and those smaller than 1 cm. had better results with ESWL.
Assuntos
Litotripsia , Nefrostomia Percutânea , Cálculos Ureterais/terapia , Cateterismo Urinário , Adolescente , Adulto , Idoso , Terapia Combinada , Estudos de Avaliação como Assunto , Feminino , Humanos , Litotripsia/efeitos adversos , Litotripsia/instrumentação , Litotripsia/métodos , Masculino , Pessoa de Meia-Idade , Nefrostomia Percutânea/efeitos adversos , Nefrostomia Percutânea/instrumentação , Nefrostomia Percutânea/métodos , Estudos Retrospectivos , Ureter , Cálculos Ureterais/complicações , Cálculos Ureterais/epidemiologia , Cateterismo Urinário/efeitos adversos , Cateterismo Urinário/instrumentação , Cateterismo Urinário/métodosRESUMO
We reviewed the records of 20 patients (21 ureters) treated during the last 5 years for ureteral stricture disease. The causes of stricture formation included ureterolithotripsy in 47.7% of the patients, open ureterolithotomy in 9.5%, other urological procedures in 23.8%, general surgical and gynecological procedures in 9.5% and miscellaneous factors in 9.5%. A total of 20 patients (21 ureters) underwent endourological treatment with balloon dilation (19) or balloon dilation and internal ureterotomy (2), with good results in 57.1% and a mean followup of 24 months. Of the 9 patients who failed endourological management 3 underwent successful open repair, 3 underwent nephrectomy, and 3 had a relatively large ureteral lumen and became asymptomatic, receiving no further treatment. The interval between injury and treatment was not a decisive factor. The length of ureteral stricture assumes the most significant parameter to predict success in the treatment of ureteral stricture. There were no intraoperative or postoperative complications. The association of balloon dilation and incision by special endoureterotomy scissors is a potentially useful technique.
Assuntos
Cateterismo , Ureter/cirurgia , Obstrução Ureteral/terapia , Desenho de Equipamento , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Instrumentos Cirúrgicos , Fatores de TempoRESUMO
We reviewed our experience with in situ extracorporeal shock wave lithotripsy for ureteral stones in 30 patients. The Siemens Lithostar unit was used for stone disintegration and no attempts were made to manipulate the calculi back into the kidney. During the study period 15 patients presented with upper, 9 with mid and 6 with lower ureteral calculi. The mean stone size was 5 x 12 mm. The success rates in stone removal, hospitalization, anesthesia, average number of shocks and kilovolts used were analyzed. Complete removal of all calculous material was obtained in 86.6% of the patients after 3 months. Followup consisted of a plain film of the kidneys, ureters and bladder, and eventually renal ultrasound 1 day and 1 to 3 months postoperatively. Routinely, patients were treated without hospitalization, while 3 had persistent stone fragments and required hospitalization for auxiliary endourological procedures. The average hospital stay for these patients was 1.6 days. Of the 30 patients 13 (43.4%) were treated without anesthesia, 9 (30.0%) received intravenous sedation and 8 (26.6%) had epidural anesthesia. Patients received 3,000 to 6,000 shock waves per session (median 4,000) at 14.0 to 19.0 kv. (median 18.1 kv.), and in 76.9% the treatment was completed after 1 session. Patients who needed more than 1 session received 3,000 to 4,000 shock waves (median 3,000) at 15.0 to 19.0 kv. (median 17.8 kv.) per additional session. Minor complications, such as hematuria, were observed in 33.3% of the patients for less than 24 hours. A small erythematous area usually was present on the abdominal wall at the shock wave entrance site and temporary ileus was noted in 2 patients. In situ extracorporeal shock wave lithotripsy with the Siemens Lithostar device is an effective method for treatment of ureteral stones in all parts of the ureter due to the ease of patient positioning.
Assuntos
Litotripsia/métodos , Cálculos Ureterais/terapia , Anestesia Epidural , Feminino , Hospitalização , Humanos , Tempo de Internação , Litotripsia/instrumentação , Masculino , Pessoa de Meia-Idade , PosturaRESUMO
Of 9 patients found to have a nonopaque filling defect on intravenous pyelogram, 6 were shown to have radiolucent urinary calculi, 2 had intrapelvic blood clots and 1 had a ureteral tumor. The diagnosis was made by computerized tomography and confirmed by surgery in all but the case of ureteral tumor. We recommend CT scanning as the method of choice for unexplained filling defects in the renal pelvis and ureter or when a nonopaque calculus is suspected.
Assuntos
Hematoma/diagnóstico por imagem , Cálculos Renais/diagnóstico por imagem , Nefropatias/diagnóstico por imagem , Pelve Renal/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Neoplasias Ureterais/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Prostatic carcinoma metastasising to the penis is a rare occurrence with only 56 cases reported in the literature. The incidence of transitional cell carcinoma arising primarily in the prostate ranges from 1. 5 to 4%. These tumors have uniformly poor prognosis regardless the type of therapy. Most of the patients die within two to six moths and very few survive beyond twelve months. A case of transitional cell carcinoma of the prostate with penile metastases and priapism is presented.
Assuntos
Carcinoma de Células de Transição/secundário , Neoplasias Penianas/secundário , Priapismo/etiologia , Neoplasias da Próstata/patologia , Idoso , Carcinoma de Células de Transição/complicações , Carcinoma de Células de Transição/patologia , Humanos , Masculino , Neoplasias Penianas/complicações , Neoplasias Penianas/patologiaRESUMO
There are still controversies about the mechanism of penile erection. Arterial aspects of impotence have received considerable attention, but just recently the venous component became widely recognized. Twenty patients with abnormal cavernosometry (flow rate over 280 mL/min) and no rigid erections (intracavernosal pressure lower than 80 mm Hg) were analyzed. Surgical ligation of the dorsal veins was performed in 12 cases, 9 of which also required ligation of the crus of each corpus cavernosum. After these ligations, erection improved sufficiently to allow satisfactory intercourse in 9 of 12 patients. Two patients became impotent after eight months of normal sexual performance. The 3 failures showed persistently high flow rates and one leakage by the crural edge which had not been ligated at surgery. In selected patients with organic impotence the venous abnormalities should be assessed routinely and dorsal veins and the crural edge of the corpus cavernosum should be ligated in an attempt to restore erectile function.
Assuntos
Disfunção Erétil/cirurgia , Ereção Peniana/fisiologia , Pênis/irrigação sanguínea , Disfunção Erétil/fisiopatologia , Humanos , Masculino , Manometria , Pessoa de Meia-Idade , Papaverina , Fluxo Sanguíneo Regional , Cloreto de SódioRESUMO
In a retrospective analysis classical radial nephrolithotomy, percutaneous nephrolithotomy and extracorporeal shock wave lithotripsy for symptomatic small nonobstructive caliceal stones were compared to evaluate morbidity. Size (less than 1 cm.) and location of the stone (caliceal and nonobstructive) did not explain the severity of the symptoms nor would they have been an indication for an operation. In 8 patients treated by an open operation, 16 treated percutaneously and 6 who underwent extracorporeal shock wave lithotripsy the procedure time, success rate, complication rate and length of hospitalization were analyzed. Followup consisted of ultrasound and/or a plain film of the kidneys, ureters and bladder 1 day and 3 months postoperatively. A nephrotomogram was included in group 3 patients. Of 30 patients 3 had persistent stone fragments for more than 3 months: 2 underwent percutaneous nephrolithotomy and 1 was treated by extracorporeal shock wave lithotripsy. A total of 28 patients (93.3 per cent) achieved complete or significant relief of pain. In the percutaneous group both patients with persistent fragments were symptomatic in contrast with the extracorporeal shock wave lithotripsy group, in which 1 patient presented with stone fragments but was free of pain. The group treated percutaneously had a shorter procedure time (60 minutes) and the shock wave group had a shorter hospitalization. On the other hand, the open operation group had a better success rate as well as relief of pain. These observations showed that small, nonobstructive caliceal stones can be responsible for persistent, severe flank pain. Since extracorporeal shock wave lithotripsy is an effective noninvasive procedure that does not require routine anesthesia and hospitalization, with prompt return of the patient to normal life, it must be considered the method of choice in these particular patients.
Assuntos
Cálculos Renais/terapia , Adolescente , Adulto , Criança , Estudos de Avaliação como Assunto , Humanos , Cálculos Renais/fisiopatologia , Cálculos Renais/cirurgia , Litotripsia , Masculino , Pessoa de Meia-Idade , Néfrons/cirurgia , Manejo da Dor , Tamanho da Partícula , Estudos RetrospectivosRESUMO
Failure of the treatment of posterior urethral stenosis ranges from 10 to 30 per cent. Strictures secondary to pull-through or transpubic urethroplasty are difficult to manage. The management of these strictures is reviewed in 21 children and 84 adults. Of the 105 patients 69 had been treated previously by a perineal pull-through technique and 36 by transpubic urethroplasty. A total of 18 patients (10 in the transpubic and 8 in the pull-through groups) whose results were fair or poor underwent internal urethrotomy with the Sachse knife as a complementary treatment after posterior urethroplasty. Internal urethrotomy provided good results in 8 patients (80 per cent) in the transpubic group and 5 (62.5 per cent) in the pull-through group. None of the patients was incontinent and there was no symptomatic urinary infection postoperatively.
Assuntos
Uretra/cirurgia , Estreitamento Uretral/cirurgia , Adulto , Criança , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
A total of 205 patients have undergone stone extraction surgery. Three groups were studied: in 70 patients the stones were removed by flank incision, in 20 patients by posterior incision and 80 patients were treated by percutaneous nephrolithotomy. Patients submitted to percutaneous nephrolithotomy had a shorter hospitalization, operative time and a significantly reduced period of recuperation, allowing earlier return to work and decreased disability. Narcotic drugs were demanded in a lower amount in the percutaneous nephrolithotomy group.
Assuntos
Cálculos Renais/cirurgia , Nefrostomia Percutânea , Cálculos Ureterais/cirurgia , Adolescente , Adulto , Idoso , Analgésicos/administração & dosagem , Criança , Feminino , Humanos , Tempo de Internação , Masculino , Métodos , Pessoa de Meia-Idade , Entorpecentes/administração & dosagem , Cuidados Pós-OperatóriosRESUMO
Varicocele is the most frequent finding in male infertility. Thirty percent of infertile male patients requesting treatment present with varicocele. Between December 1971 and December 1984, 151 infertile patients presenting varicocele were treated in this study: 28 underwent medical treatment, 38 surgical treatment, and 23 both medical and surgical treatment. The spermograms of all the patients were studied before and after treatment. The following variables were considered: volume, sperm count, percentages of general motility and of grade III sperm, and of oval forms. There was not a significant statistical difference in the analysis of the spermogram parameters before and after treatment in the three groups. The pregnancy rate for the medical-surgical group was 60.9% and for the surgical group 47.4%--not a statistically significant difference. The purely medically treated group had a pregnancy rate of 25%, which is significantly lower than the other groups.